Sunset Yoga on the Farm Waiver

Participant Health & Liability Waiver

Luminous Yoga and Wellness | Jennifer Misterka | October 9, 2026 – Sunset Yoga on the Farm Fundraiser
Full Name

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Email
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Phone Number
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Emergency Contact

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Emergency Contact Phone Number
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Please review each of the following conditions. Check any that apply to you. This information is kept confidential and is for the safety of your experience.
Please check any that apply:
If you checked anything above, please share any details you'd like Jennifer to know:
By submitting this form, I acknowledge that I am voluntarily participating in today's session which includes movement and breathwork. I understand that it is my responsibility to inform the practitioner of any health conditions that may affect my participation. I release Luminous Path Yoga and Wellness and Jennifer Misterka from liability for any injury or discomfort arising from my participation.
Date

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Participant Health & Liability Waiver